Following on from Part One of our Pause for thought article we are taking a moment to look at some of the symptoms women can suffer during their menopause. Our very own Menopause Doctor, Dr Shahzadi Harper explains some of the issues she has faced when treating patients and looks at some of the treatments available to help women through this transition as painlessly as possible.
Embarrassment around sex, libido, and ageing is one of the biggest hurdles for women and their GPs to overcome. This is obviously an endemic cultural issue which can’t be solved overnight. However, it’s still important to try and make patients feel comfortable with having these conversations.
Listen and be sympathetic. Many of the menopausal symptoms are deeply personal. Physical issues like vaginal dryness can be almost impossible to broach with a pharmacist or GP, and yet without treatment can be extremely painful for many women. The deeper psychological issues around body image and self-worth will often need to be treated with therapy.
Each case is individual. Reduced oestrogen production affects the brain, which in turn affects mood. It affects the hypothalamus, causing hot flushes and night sweats, which in turn can cause poor sleep, leading women to suffer problems with memory and ‘feel like they are going mad’. And it affects the skin, which can lead to problems with elasticity, and in many women, vaginal dryness, and vulvodynia. In total, 34 different menopausal symptoms have been reported.
While some of these can be mitigated through lifestyle choices, such as increased exercise, reduced alcohol intake, and changing diet, others may require diagnosis through sensitive discussion with healthcare professionals. I only use blood tests to measure levels of the reproductive hormone, FSH (follicle-stimulating hormone), in instances of early menopause or if a woman is using a progesterone-only contraception, like the Mirena coil.
Care should be taken to prescribe the correct treatment for symptoms as, again, early menopausal signs are often missed or misinterpreted, especially when they take the form of migraines, insomnia, or anxiety. Every healthcare professional should have access to a menopause doctor, and while this isn’t always possible, taking the time to diagnose menopausal symptoms correctly can reduce the number of subsequent appointments. As a rule, if a pharmacist suspects symptoms of being demonstrative of menopausal transition, they should advise that patient to contact their GP or to see a menopause doctor.
Dependent of whether a woman’s menopause has begun naturally, or triggered surgically, treatment will need to be tailored to suit. In cases where a woman has suffered oestrogen-receptor-positive breast or ovarian cancer, hormonal treatments are not appropriate and natural remedies need to be sourced.
These can take the form of certified organic, hormone-free lubricants and vaginal laser treatment, used to reverse the effects of vaginal atrophy. Sourcing gentle and effective brands is important as many contain chemicals dangerous to a woman’s health.
Cognitive Behavioural Therapy can be recommended to handle anxiety, insomnia, and hot flushes, and some herbal supplements can also be used, although emphasise caution as they can interfere with other medication.
Hormone-Replacement Treatment (HRT) has received a lot of negative press, although it is the most effective way to treat menopausal symptoms; 95 per cent of women say that they would prefer to seek natural options before trying the drug. It is, as the name would suggest, a way of replacing the hormones that have ceased to be produced naturally. Studies in 2000 and 2001 raised concerns that HRT may increase the risk of breast and ovarian cancer, even heart disease, which is why its long-term use has been questioned. This evidence has gone on to be dismissed as inaccurate.
In my clinic, I offer women an in-depth consultation to assess their needs as an individual. Usually my advice takes the form of a combined approach, including lifestyle modification, natural remedies, and HRT.
Most women will spend a third, to half their lives in menopause. It is important to identify menopausal coping strategies early to maintain quality of life and well being. Life-coaching and emotional support is also a big part of what I do as often women need a little boost into their third act.
If you are at all unsure about managing your menopause symptoms it is important you speak to your GP or call me on 0207 637 8820 or email to book a consultation. Your local GP surgery might be oversubscribed so make sure you make the most of your 10 minute appointment by downloading and filling out my Menopause symptom checker, it’s a great way to get the conversation started. You can also find us on Facebook, Twitter, Instagram and LinkedIn.